Name*

First Last

Email*

Phone*

Cell Phone

Address*

Street Address Address Line 2 City State ZIP Code

Are you over 18 years old?*

Yes
No

Are you eligible for employment in the U.S.?*

Yes
No

*In accordance with the City of Rochester Ordinance No. 2014-155, as of November 18, 2014 employers will no longer inquire as to an applicant’s prior criminal conviction until after the initial employment interview. If granted a second interview with SPCC, any prior criminal conviction, including a DWI, must be disclosed and discussed privately with SPCC’s CEO. If this should apply to you, it is your responsibility to contact Laurie Valentine, CEO at lvalentine@spcc-roch.org

If you have a Child Protective Indication you must disclose this and offer an explanation if applicable. Because we need to ensure the safety of the children we work with, depending on the circumstances this may affect your eligibility. In the event that you are hired and it is subsequently discovered when we complete the required CPS clearance check, this will likely result in termination of your employment.

In addition, because most positions at SPCC require you to drive, you must possess a valid NYS driver’s license with a driving record that meets Agency Insurance requirements. In the event that you are hired and it is subsequently discovered when we complete MVC that your record does not meet agency requirements, this could result in termination.

Employment Desired

Position for which you are applying:

Are you seeking full or part-time employment?

full-time
part-time
either

If part-time, specify days and hours available:

Date available to start:

Are you currently employed?*

Yes
No

May we contact your present employer?*

Yes
No

How did you learn of this position?

How did you learn of this agency and/or program?

Education

Please check all levels of education you attended:*

Select All
High School
College
Graduate

High School Education*

Please list the name and address of the school you attended as well as the dates and degree/diploma.

College Education*

Please list the name and address of the school you attended as well as the dates and degree/diploma

Graduate Education*

Please list the name and address of the school you attended as well as the dates and degree/diploma

Are you planning to pursue further education?*

Yes
No

If so, when, where and what courses?

List any scholastic honors, offices held and activities involved in during high school and college (exclude any information which would reveal race, religion, sex, age, color, national origin, sexual orientation, marital, disability or other protected status):

List and describe any other educational opportunities you have pursued and specialized training you have received:

List any special skills you possess:

Have you ever served in the U. S. military?*

Yes
No

Service branch:

Date Entered:

Date Separated:

Final rank:

Would you be willing and able to perform all the tasks required of the job for which you are applying?*

Yes
No

If not, explain which tasks:

CAPTCHA

SPCC Employment Application

Employment Desired

Education

Main Office

To report suspected child abuse or neglect, please call Monroe Co. Child Protective Services (CPS) at 1-800-342-3720.